수술 전후 항혈소판제제의 관리
Management of Perioperative Antiplatelet Therapy
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약물용출 스텐트를 시술받은 환자가 수술을 해야하는 경우항혈소판제 치료 지속 여부에 대해 많은 논란이 있다. 약물용출 스텐트를 시술받은 환자는 스텐트 혈전증 발생 시 대부분 급성 심근경색증으로 발현하고 사망률이 높기 때문에스텐트 혈전증 예방을 위해 반드시 이제 항혈소판제를 사용한다. 또한 항혈소판제를 유지하면서 수술하는 경우 출혈의위험이 증가하는 것 역시 사실이다. 그러나 수술 중 출혈 증가는 수술 결과 및 사망률과 직접 관련이 없기 때문에 수술중 지속적인 항혈소판제 치료를 권장하고 있다. 약물용출 스텐트를 시술받은 환자는 두개 내, 척주관 및 후안방 수술 등고 위험 수술을 제외한 모든 수술 시 가능한 이제 항혈소판제를 유지해야 한다. 특히 항혈소판제 중단의 가장 많은 원인이 되고 있는 내시경이나 발치를 위해 항혈소판제를 중단하는 경우는 절대 없어야 하겠다.
Abstract
Drug-eluting stent (DES) implatation was the major method of coronary revascularization and marked reduction in target-lesion revascularization. Stent thrombosis (ST) is a severe complication that is associated with a high incidence of acute myocardial infarction and death. To prevent ST, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for at least 12 months. The premature discontinuation of DAPT is the single most significant predictor of perioperative ST. The risk of surgical bleeding is increased approximately 20% by aspirin or clopidogrel alone, and 50% by DAPT. But the increased risk of perioperative bleeding is not necessarily associated with increased mortality or surgical outcome. Usually, the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during high risk surgery in a closed space. We remember that DES are never low risk situation for ST and aspirin must never be stopped in all patients with DES.
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